LUNG transplant was associated with markedly longer early survival in selected patients with lung-limited stage IV NSCLC.
The prospective, single-center registry study included 98 adults with medically refractory, lung-limited stage IV non-small cell lung cancer (NSCLC). Of these, 17 underwent lung transplant, while 81 met transplant eligibility criteria but were unable to undergo the procedure because of logistical, financial, or geographic barriers and received medical management alone.
All transplant recipients had respiratory failure, compared with 68% of medically managed patients. Those receiving transplant also had substantially worse functional status at baseline.
Estimated 1-year overall survival was 100% among transplant recipients compared with 40.8% among patients receiving medical management alone, an absolute difference of 59.2 percentage points. No deaths occurred among transplant recipients during the primary comparative follow-up period, compared with 52 deaths among the 81 medically managed patients.
Eligible patients had progressive cancer despite recommended systemic therapies and disease confirmed to be confined to the lungs through comprehensive staging. Most transplant recipients underwent bilateral lung transplantation using an operative approach designed to minimize tumor dissemination.
All 17 transplant recipients had adenocarcinoma. Molecular profiling identified EGFR variations in three patients, KRAS variations in two, and BRAF V600E in one. All but two had previously received immune checkpoint inhibitors.
Early postoperative outcomes were broadly similar to those seen among 306 patients who underwent lung transplant for end-stage pulmonary disease without cancer. Estimated 1-year posttransplant survival was 100% in patients with NSCLC and 88.1% in recipients without cancer.
Cancer control was not universal. Four of the 17 transplant recipients developed clinically evident NSCLC recurrence or progression. At extended follow-up through January 31, 2026, two transplant recipients had died.
The findings therefore do not suggest that lung transplant restores normal life expectancy or represents an established treatment for stage IV NSCLC. Instead, they indicate a potential survival benefit in a narrowly selected group with lung-limited disease, exhausted systemic treatment options, and respiratory failure.
The authors noted that the small sample size, single-center setting, nonrandomized design, and specialized transplant expertise limit generalizability. Longer-term follow-up, including assessment of late recurrence, complications, and quality of life, will be needed to determine whether lung transplant can assume a broader role in selected patients with advanced lung cancer.
Reference
Bharat A et al. Lung Transplant for Refractory Lung-Limited Stage IV Non–Small Cell Lung Cancer. JAMA. 2026;336(6):484-495.
Featured Image: amazing studio on Adobe Stock.
Each article is made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.
